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Community leave

This essay is about the escort on community leave using transactional analysis theory in discussion throughout the length of the essay. According to (Webb, 2011) ‘Transactional analysis is a model of communication developed by Eric Berne (1964) that helps professionals to understand their style of communication, what effect it has on others, and how to develop more effective communication’. According to TA as sometimes called, we could distinguished clearly between three types of behaviour which could be traced to ourselves from different source refers to parent, adult and child ego states.

Also, throughout this work, name involved is changed in order to stay in line with NMC code (2005) and to maintain confidentiality. I had the privilege to escort a patient to the community while I was a support worker in one of the trust hospitals. (NHS, 2016) In accordance to Mental Health Act 1983, section 17, going on leave from the hospital should form an important part of the patient’s care as he or she is recovering and it also aids rehabilitation process. This means that while detained under the Act, patient may be able to leave the hospital if authorised by the doctor or clinician (also known as the Responsible Clinician) in charge of the patient’s care. Usually, the relationship between patients and nurses or carers is that of parent to adapted child. Parent to adapted child relationship simply means the child takes instructions from the parents for their own safety. This is so because in most cases, the carers followed laid down instructions and rules on daily bases to deliver safe and efficient care of the patient concern. I was informed by the charge nurse during the morning handover section of the shift that I will be taken Mr. Jones on community leave. There I prepared my mind for the task of the day. Immediately after the handover I approached the patient while still in bed to inform him that I have been assigned to escort him to the community for his leave and that I would need his cooperation, which he obliged politely ‘oh that is great’ According to the handover information section, Mr Jones was not in his right state of mind, a bit confused and agitated over the night, I approached him for a short briefing in relation to his well-being and how has he prepared for his leave while still lying in his bed. The following discussion ensue;

Nurse: Hello Mr. Jones, how was your night? I have to use high volume tone voice because this patient has been diagnosed of having hearing impairments problem.

Patient: Good but I was a bit worried about my section 17 leave today.

Nurse: what are your worries about today, Mr Jones? I could noticed a bit of anxiety in him, which prompted me to lean forward (Gerard Egan SOLER) towards his bed space to give him more confidence to encourage him to talk to me.

Patient: He then opened up to talk about the mother, I was thinking if I could be allowed to visit my mom toady as is being long I have seen her.

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Nurse: I have explained to you earlier on that issue. Your section only covers a radius of 10 miles from your present location which is the hospital and does not covers your mom location or place of residence. I advised you to give your mom a phone call to meet you over in the café shop you planned to have your breakfast.

At this point, I could heard him took a deep breath with a sigh of relieve of dislike and a frown face (Gerard Egan SOLER) but he was still able to maintain calmness and continue with the conversations.

I continue to re -assure him that the issue of visiting the mom will be addressed in his next ward round meeting.

(NICE Guideline, 2017) Ward rounds are critical to the smooth flow of the patient journey as they are the key method by which patients in hospital are systematically reviewed by the multidisciplinary team (MDT). During a ward round, the current status of each patient is established and the next steps in their care planned. Ward round meeting is made up of the patient or the representative chosen, the nurse in his or her care including other members of alien health professionals as the case maybe.

Patient: That’s fine. He continued, how about the money for my shopping?

Nurse: I assured him that the money has been approved by the MDT- Multidisciplinary Team and it is in the safe in the nurse office ready for you to pick it up when set to go out of the unit. It is the policy of the trust I work to know and subsequently approve a certain amount of money above the usual patients’ weekly allowance for all the patients going on leave. In relation to the above scenarios, it depicts an adaptive child and nurturing parent relationship.

Nurturing Parent– This Parent type is caring and concerned and may often appear as a mother-figure (though men can play it too). They seek to keep the child contented, offering a safe haven and unconditional love to calm the Child’s troubles. (Newton, 2016)

With this conversations, my client appears to be happy and calm. He got off the bed went straight to his bathroom as it is a self – contain accommodation, attends to his personal hygiene and went to meet his peers in the lounge watching television and chatting. Thereafter, I had his description made, his apparent clothes and shoes that is putting on for the outing need to be recorded in section 17 form. Time, date and sign by the patient and countersign by the charge nurse authorising the leave after the mental state descriptions done and entered in the computer. (Mediacal Protection, 2017) “We cannot always rely on our memories to recall a particular consultation or episode of care. Maintaining complete contemporaneous records can provide evidence of care given and can prove invaluable in defending a complaint or claim”. Mr Jones has 4 hours to spend in the community. He is to leave the hospital unit by 10am and he is expected back to the hospital ward by 14.00 hours, all these information are recorded in the section 17 form and including the written mental state entered in the computer.

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Unfortunately and very interesting, Mr Jones has been on a wheelchair from the inception of his admission to the ward. He was referred from the (MOJ) Ministry of Justice where, he is expected to be serving a life jail sentence term in the prison for murder of his wife and while in the course of his arrest, he jumped off a 3 – storey building. This caused him a leg fracture which made him incapacitated and remained in a wheelchair while receiving treatment along with diagnosis of his mental state deterioration.

In a short time, at exactly 10am I assisted Mr Jones with the wheelchair on board a bus and we started our journey to the city centre of one of the nearby community village in the area. After a silence, the following discussion ensue;

Nurse: Mr Jones, are you ok!

Patient: Yeah. But I am anxious getting down to the city for my shopping and possibly to see my mum if she turns up as arranged.

Nurse: I continue to re-assure him that the mom will come around as arranged. I could see how happy he was on seeing the mom already hanging out at the coffee shop waiting for our arrival. I called his name loud and pointed to his fractured leg to remind him that it is not safe for him to stand up from his chair because the leg has not healed enough. He could lose his balance and fall in the process thereby complicating issues he immediately reacted to my intervention and maintained his seat while he hugged the mom. I maintained an arm length distance to give them a little bit of privacy but maintaining a very good eye contact while listening to their conversations attentively without interruption but reminding him that swearing language is not allowed. Thereafter, I beckoned to one of the bar attendant to please come to us to take my client’s and the visitor’s orders while I refused his offer politely. Though he was not happy about it. I told him I appreciate his kindness but I have had my breakfast before leaving the ward. I have to implore this to maintained patient and staff relationship professional boundaries. I maintained a nurturing parent ego state above by reminding him of his fractured leg politely and calmly for his safety and not to cause harm to himself accidentally if he falls over. On the other hand, if I have to act as a critical parent I would have acted as if am given an order, coercive, even shouting angrily and pointing my hand at his leg. My action might erode his dignity and respect, thereby feeling unsafe with me.

Boundaries are defined by the NMC (2012) as “the limits of behaviour which allow a nurse or midwife to have a professional relationship with a person in their care” and by the National Council of State Boards of Nursing (1996) as “the spaces between the nurse’s power and the patient’s vulnerability”. The relationship between a nurse and the person in their care is a professional relationship based on trust, respect and the appropriate use of power. Boundary issues range from giving or receiving a gift from patients, to picking up groceries for a housebound patient, to social contacts with former patients or their relatives, to having a sexual relationship with patients. While there is guidance for registered health professionals regarding maintaining professional boundaries (NMC, 2012), including sexual boundaries (Council for Healthcare Regulatory Excellence (CHRE), 2009), there does not appear to be anything specific for nonqualified healthcare workers (Nursing Times, 2014)

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According to literature writer, (Ciucur, 2013), nurturing parent judgement and behaviours can be supportive, warm and nurturative. All these are perceived as positive aspect of nurturing parent. Meaning caring, loving and helping a child to remain safe and protected from danger or harm. While all these stand for positive aspect of nurturing parent, overprotecting, discouraging personal developing of others, it indicates negative part of nurturing parent.

Also, when the Parent’s behaviours are controlling and critical, but with a positive role in supporting others, we see a positive part of the Critical Parent. When these traits are abusive and with no respect to others, even attacking individuals, the person is exposing the negative part of the Critical Parent (Ciucur, 2013).

Again we have positive and negative traits of adapted child. An adapted child positively is linked to be highly emotional instability in addition to being detailed, creative and imaginative. But when in a negative Adapted Child Ego State, a person can show discouragement or irritation in facing an obstacle, fear and helplessness, more stress in accomplishing tasks. The person can be angry, fearful, guilty or ashamed, turning the anger inwards (leading to psychosomatic illnesses) and being self-discounting, or outwards, exposing a rebel (passive-aggressive) behaviour (Ciucur, 2013).

After about half an hour left out of the allocated time, I broke the conversation of my client politely to remind him to round up his conversations with the mom and get set to return to the unit.

Nurse: sorry John, we have to go. Are you happy and is there anything you wish to do that is not yet done?

Patient: No. I am very happy. I had a lovely outing today especially using the opportunity to see my mom that I have not seen for a long time. It was very sympathetic seen tears roily down his checks and the mom too cries.

Nurse: I continue to reassure John to calm down and concentrate on working towards his recovery to gain his freedom back.

I then asked the bus driver to lower the lift of the vehicle to allow me wheel John inside the bus. We got back to the unit at about 15 minutes to 1400 hours.

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