IntroductionReflection is defined as an individual process that can lead to new perspectives for nursing students and support contemporary means of gaining 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 whilst providing safe, high quality patient care. Reflection can also be described as the conscious synthesis of different perspectives which can be very useful for developing professional confidence and competence (Sarikaya and Nalbant 2014). Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay In mental health nursing, reflection should be specific to the care we deliver to our clients and how it impacts us on both a professional and personal level (Summer 2010). This reflective assignment aspires to critically evaluate my performance as a nursing student during the internship. I will analyze and evaluate my performance across three skill categories using the Gibbs Reflection Cycle (1988). Gibbs (1988) devised a theoretical framework that uses six stages to understand the reflective process (Appendix 1). Applying Gibbs' (1988) reflective cycle allows us to make sense of a particular situation by assessing our feelings, evaluating our actual 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 confidentiality rights in line with the NMBI Code of Professional Conduct and Ethics (Nursing and Midwifery Board of Ireland 2015). Case Scenario: Margaret is a 61 year old woman admitted to an authorized center for clients with dementia. After the accumulation of troubling events two years earlier, Margaret's family decided to seek medical help. Margaret had become very withdrawn, forgetful, easily agitated and distressed, and eventually became quite aggressive, which was extremely out of character for her. Margaret has a history of diabetes but has always managed it on her own without issue until recent cognitive decline. Margaret's signs and symptoms of dementia progressed at an alarming rate and was very difficult for her family. Margaret no longer recognizes her family, has developed dysphasia and has difficulty swallowing, has become doubly incontinent and her mobility has rapidly decreased. A complication due to Margaret's immobility is bed sores in the sacral area which require daily medication, pain management and help to relieve pressure on the area. Establish care priorities: To determine care priorities the nurse must first establish specific treatment goals (Urden et al. 2016). By assessing the client as a whole, the nurse establishes clear treatment goals, becomes aware 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 trainee nurse I was immediately given the workload and informed that I was now Margaret's key worker. I took a few minutes to read Margaret's chart and discovered that she was in a very restless and agitated phase of her illness. Then I entered Margaret's bedroom to introduce myself and observedwho seemed quite distressed and felt that I would have a difficult task in establishing her care priorities through verbal interaction. Feelings: digesting the fact that I was now Margaret's key worker I suddenly felt nervous. When I entered Margaret's bedroom and realized how advanced her illness was and how distressed she appeared, I felt an overwhelming wave of anxiety through my body.body and immediately began to doubt my abilities. As I held her hand and spoke softly to her, I became very emotional thinking about how young Margaret was and how quickly her dementia had dramatically changed her life forever. Assessment: While conversing with Margaret I was unable to assess any valid information due to her dysphasia and so she used the observatory's assessment tools and previous clinical documentation to determine what her top care priorities were. I felt that using assessment tools was a better approach to prioritizing Margaret's needs, and my preceptor agreed and commended my clinical decision-making skills. As I discussed my emotional reaction to Margaret's discomfort with my preceptor, she reassured me that it was a natural response and not to be embarrassed by it (Mafullul and Morriss 2000, Youssef 2016). Analysis: The Waterlow scale (Appendix 2) allowed me to evaluate Margaret's bed sores and her risk of developing others. Being diabetic, Margaret is also more susceptible to pressure injuries 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 restore. Margaret's bedsore required daily dressing changes following specific guidelines established by a tissue viability nurse, ongoing daily assessment for additional bedsores, frequent rotational positioning, close blood sugar monitoring (BSL), medication management and comprehensive nursing care regarding diet and fluid intake and incontinence care. Bottom line: I feel like I could have handled the situation better by expressing my anxiety to my preceptor sooner. Upon reflection, although my learned knowledge about dementia, diabetes, and pressure wound care from lectures and evidence-based research was highly applicable in this scenario, I also feel strongly that no amount of studying can prepare a student for the experience direct and the overwhelming feelings that are summoned by participating in clinical training (Rassouli et al. 2014). Action Plan: Going forward I will try to make my feelings and anxieties known to my co-workers and try to remember that I am after all still a nursing intern on a steep learning curve. Medication management: Nurses are perceived as pharmacovigilant intermediaries in medication management (Johnson-Pajala et al. 2015). In particular, patients with dementia are considered to be at increased risk of medication mishaps and must therefore be appropriately assessed 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 patients both physically and mentally (Sorensen et al. 2016). Description: Margaret has been prescribed insulin for diabetes, Memantin for dementia, Zimovane to aid sleep, quetiapine for agitation, clonazepam PRN for discomfort and paracetamol PRN for pain due tobedsore. I felt confident in my abilities to monitor BSLs and administer an insulin injection subcutaneously. However, I discovered that I had no knowledge of the drug Memantin used for dementia and I also became very aware of my inexperience in managing fluctuating BSLs when I checked Margaret's BSL and found it to be 3.0 mmol. Feelings: I immediately reported BSL of 3.0 mmol and was urgently advised to give Margaret Weetabix and a drink of Lucozade. I suddenly felt incompetent and frustrated with myself because I theoretically knew I was doing this, but had never had any physical experience treating a patient who had a rapidly fluctuating BSL. I felt uncomfortable and anxious about how quickly Margaret's BSL might change and how important frequent monitoring would be as her key worker. Evaluation: Although I felt incompetent and anxious during this experience, I also knew that I needed to report the low BSL reading to my preceptor immediately. During reflection, my preceptor asked me questions about when to discontinue insulin and when and why appropriate snacks should be given to support BSL. I also reported knowing nothing about the drug Memantin and my preceptor assured me that the nursing staff will not always know every drug but must continue to educate themselves as much as possible at every opportunity (Sneck et al. 2016). Analysis: I believe I could have been more assertive and clarified my knowledge of what BSL to act on, when to discontinue insulin, and taken a moment to consult the MIMS to assess an approximate level of knowledge on unknown medications until I could conduct further research. Conclusion: Margaret's medication management proved more complicated than I expected and I soon learned once again that clinical practice and experience with physical patients would instill vital practical knowledge and improve my confidence levels and competence (Khalaila 2014). Action Plan: For future practice, I will make an effort to ask questions at all times, I will report information especially if I am unsure or have no experience in the area and I will try to ensure that I am aware of all medications that are prescribed to clients under my cure at the first opportunity given to me. Teamwork and Collaboration: For effective integration of nursing care, the identification of teamwork and collaboration is essential (Contandriopoulos et al. 2015). Teamwork helps preserve the core principles of nursing values ​​and supports evidence-based practice and research (Evans 2015). The collaboration of multidisciplinary teams is viewed positively by nursing staff and is seen as an important support in providing safer and high-quality care to patients (Sollami et al. 2015). Description: Margaret's pressure wound was deteriorating and when I changed the dressing I noticed a large amount of exudate at the wound site. Although paracetamol PRN had been administered 30 minutes before wound care, Margaret was very distressed and was obviously still in pain. As the day progressed Margaret refused to eat, drink, take oral medications and was observed to be flushed and sweaty. I immediately began recording his vital signs. Margaret's blood pressure, SpO2 and respiration levels were all normal, however her temperature had risen to 38.3 degrees and her pulse was 122 beats per minute. Emotions: I immediately became alarmed by Margaret's increased temperature and heart rate and instinctively felt that she had a possible infection. I argued,.