IntroductionReflection is defined as an individual process that can lead to new perspectives for nursing students and support contemporary ways of acquiring knowledge while developing clinical reasoning (Peate 2016). According to the Nursing and Midwifery Board of Ireland (NMBI 2015), reflective practice in nursing promotes and enhances learning while providing safe, high-quality patient care. Reflection can also be described as the conscious synthesis of diverse perspectives that can be particularly useful for developing professional confidence and skills (Sarikaya and Nalbant 2014). Say no to plagiarism. Get a tailor-made essay on “Why violent video games should not be banned”?Get an original essayIn mental health nursing, thinking needs to be specific to the care we provide to our clients and their impact on us, to both professionally and personally (Summer 2010). This reflective assignment aspires to critically evaluate my own performance as a registered nursing student during an internship. I will analyze and evaluate my performance under three competency headings using Gibbs' (1988) reflection cycle. Gibbs (1988) designed a theoretical framework that uses six stages to encompass the reflective process (Appendix 1). Applying Gibbs' reflective cycle (1988) allows us to make sense of a particular situation by evaluating our feelings, evaluating our effective practice and also understanding what can be improved for future clinical practice (Ritchie 2012, Husebo et al. 2015). For the purposes of this personal reflection, all names of staff and service users have been changed to protect privacy rights, in accordance with the NMBI Code of Professional Conduct and Ethics (Nursing and Midwifery Board of Ireland 2015) . Case scenario: Margaret is 61 years old. woman admitted to an approved center for clients suffering from dementia. Following a series of disturbing events two years previously, Margaret's family decided to seek medical attention. Margaret had become very withdrawn, forgetful, easily agitated and distressed, and eventually became very aggressive, which was completely unlike her. Margaret has a history of diabetes, but she always managed it herself without problems until her recent cognitive decline. Margaret's signs and symptoms of dementia progressed at an alarming rate and it was very difficult for her family. Margaret no longer recognized her family, developed dysphasia and difficulty swallowing, became doubly incontinent and her mobility rapidly declined. A complication due to Margaret's immobility are pressure sores on the sacral area which require daily dressing, pain management and help to relieve pressure on the area. Establishing Priorities of Care: In order to determine priorities of care, the nurse must first establish specific treatment goals (Urden et al. By assessing the patient as a whole, the nurse establishes clear treatment goals, takes awareness of potential risk factors and can then begin to plan, implement, and evaluate an effective and therapeutic plan of care for the client (Kendall and Bergenstal 2001, Townsend 2014). Description: On my first day as a nurse trainee, I was immediately given my own workload and informed that I was now Margaret's key employee. I took a few moments to re-read Margaret's file and discovered that. she was in a very agitated and agitated phase of herdisease. I then entered Margaret's room to introduce myself and observed that she seemed very distressed and felt that I would have a difficult task establishing her care priorities through verbal interaction. Feelings: coming to terms with the fact that I was now Margaret's key employee I suddenly felt nervous. As I entered Margaret's room and realized how advanced her illness was and how distraught she seemed, I felt an overwhelming surge of anxiety in my mind.body and I immediately started to doubt my abilities. As I held her hand and spoke softly to her, I also became very moved by Margaret's youth and how quickly her dementia had radically changed her life forever. Assessment: In speaking with Margaret, I was unable to assess any valid information due to her dysphasia and dysphasia. so she used the observatory's assessment tools and previous clinical documentation to determine what her top care priorities were. I felt that my use of the assessment tools was a better approach to prioritizing Margaret's needs and my preceptor agreed and complimented my clinical decision-making skills. While discussing my emotional response to Margaret's distress with my preceptor, she reassured me that it was a natural response and that I should not be embarrassed by it (Mafullul and Morriss 2000, Youssef 2016). Analysis: The Waterlow scale (Appendix 2) allowed me to assess Margaret's pressure sore and her risk of developing more. As a diabetic, Margaret is also more susceptible to pressure ulcers due to poor circulation and neuropathy as well as her inability to move independently (Waaijman et al. 2014). My preceptor praised me for recognizing this and my confidence in my knowledge began to be restored. Margaret's pressure sore required daily dressing changes following specific guidelines established by a tissue viability nurse, ongoing daily assessment for other pressure ulcers, frequent rotational positioning, close monitoring of blood pressure rate. blood sugar (BSL), medication management and comprehensive nursing care regarding diet. and fluid intake and incontinence care. Conclusion: I think I could have handled the situation better by expressing my anxiety to my preceptor earlier. Upon reflection, while my acquired knowledge about dementia, diabetes, and pressure ulcer care, acquired through lectures and evidence-based research, was highly applicable in this scenario, I am also convinced that no studies cannot prepare a student for the direct experience and overwhelming feelings that are summoned by participating in a clinical placement (Rassouli et al. 2014). Action Plan: Moving forward, I strive to make my feelings and anxieties known to my co-workers and will try to remember that after all, I am still a nursing intern on an incline steep. learning curve. Medication management: Nurses are seen as pharmacovigilant intermediaries in medication management (Johnson-Pajala et al. 2015). Clients with dementia in particular are considered to be at increased risk of pharmaceutical mishap and therefore should be assessed appropriately to determine their ability to manage medications (Lehane et al. 2016). In many cases of dementia, medications are fully monitored and administered by the nurse and have been shown to benefit treatment outcomes.patients, both physical and mental (Sorensen et al. 2016). Description: Margaret was prescribed insulin for diabetes, Memantin for dementia, Zimovane for sleep aid, Quetiapine for agitation, Clonazepam PRN for distress and Paracetamol PRN for pain due to her pressure sore. I was confident in my abilities to monitor BSL and administer a subcutaneous insulin injection. However, I discovered that I had no knowledge of the drug Memantin used to treat dementia and also became aware of my inexperience in dealing with BSL fluctuations when I checked Margaret's BSL and discovered that it was 3.0 mmols. Feelings: I immediately reported the BSL of 3.0 mmols and was advised to urgently give Margaret Weetabix and a glass of Lucozade. I suddenly felt incompetent and frustrated because I theoretically knew how to do this, but I had never had any physical experience treating a patient whose BSL fluctuated rapidly. I felt uncomfortable and anxious about how quickly Margaret's BSL could change and the importance of frequent monitoring as a key worker. Assessment: Although I felt incompetent and anxious during this experience, I also knew that I needed to report the low level of BSL to my preceptor immediately. During reflection, my preceptor asked me questions about when insulin should be withheld, and when and why appropriate snacks should be given to maintain BSL. I also reported knowing nothing about the drug Memantin and my preceptor assured me that nurses will not always know all the medications but should continue to learn as much as possible at every opportunity (Sneck et al. 2016). Analysis: I think I could have been more assertive and clarified my knowledge about what to do with BSL, when to withhold insulin, and taking a moment to consult MIMS to assess an immediate level of knowledge on previously unknown medications. so that I can conduct more in-depth research. Conclusion: Managing Margaret's medications proved more complicated than expected and I soon learned once again that clinical practice and experience with physical patients would instill in me vital practical knowledge and improve my level of confidence and competence (Khalaila 2014). Action Plan: For future practice, I will strive to ask questions at all times, report information, especially if I am uncertain or inexperienced in the field, and try to make sure I know all the medications prescribed to clients in my care at the earliest opportunity. Teamwork. and Collaboration: For successful nursing integration, identifying teamwork and collaboration is essential (Contandriopoulos et al. 2015). Teamwork helps preserve the core tenets of nursing values ​​and supports evidence-based practice and research (Evans 2015). Collaboration between multidisciplinary teams is perceived positively by nursing staff and is considered a major support in providing safer, high-quality care to clients (Sollami et al. 2015). Description: Margaret's pressure ulcer was deteriorating and while changing her dressing I noticed a large amount of exudate at the wound site. Although paracetamol PRN was administered 30 minutes before wound care, Margaret became very distressed and was still visibly in pain. As the day progressed, Margaret refused to eat, drink, take oral medications and was observed to have rash and,.