Professional Documents
Culture Documents
The following essay describes a critical reflection on events that arose during a DVD
towards a PG Certificate in the Practice of Primary Mental Health the student was
depression. The entire process was filmed and graded by a member of staff who was
playing the role of the patient. A brief definition of reflection will be given, with the
plan for future experiences (Kemmis, 1985). This essay will refer to John’s reflective
model as a framework for reflection, focussing on the issues that can affect patient-
and uses that patients own knowledge and experience of distress to guide the
assessment, Richards & Whyte, (2008). Research dictates that this form of interview
practice is correlated with patient satisfaction and improvement (Lovell & Richards,
2000).
The lecturer was playing a patient who was depressed. Her symptoms included
low mood, trouble sleeping, drinking alcohol and smoking cannabis more than usual,
and having difficulty concentrating. The aim of the interview was to gather
information about the patient’s current problems and provide them with accurate,
evidence-based information which they can utilise to help combat these problems.
Research shows that this form of facilitated self help is successful in the treatment of
depression and anxiety, (Lovell, Bee, Richards & Kendal, 2006). My interview was
structured around Richards & Whyte’s (2008) assessment criteria, therefore was
tried to appear warm and welcoming by smiling and using open body language.
PHQ-9 (Kroenke, Spitzer &Williams, 2001) and GAD-7 ( Spitzer, Kroenke, Williams
& Lows, 2006) questionnaire. The patient did not seem affected by the issue of
confidentiality but sighed a lot during the psychometric measures as though they were
hard work. Once these were finished I asked if she could say in her own words why
(2008). I began by asking open ended questions such as “what is the problem” and
then asking increasingly specific questions such as “how is your sleep” so that the
patients account was placed at the centre of the interview. However, the issues around
being assessed and the presence of a time limit were always at the back of my mind. I
felt nervous that I would fail the assessment or run out of time. This made my
questioning style much more regimented than it should have been. As a consequence
of this, I feel it pulled away from the patient centeredness of the interview and that
she may have felt a little rushed. Furthermore, my worries around running out of time
meant that I did not always explore her answers to my questions to the degree that I
would have in a real life situation. In future practice I will try to use the funnelling
technique more effectively and spend more time following up the patients answers.
During the interview I asked the patient how she was feeling physically, to
which she replied that she was tired. From this, I asked about her current sleep
patterns and the quality of her sleep. She revealed that she was going to bed much
later (3-4 am) and as a result getting up later in the afternoon. I began to ask more
specific questions about things which would affect the patient’s sleep such as the
amount of tea and alcohol she was drinking. The patient replied that she drank
between 6 and 7 cups of tea a day and switched to wine in the evening. At this point I
began to educate her about the influence of caffeine and alcohol on sleep and that she
should try and cut down. Unfortunately, on telling the patient this, her body language
became much more sunken and closed off as though she was being told off and her
answers to questions also become less detailed. At the time I felt pressurised to
educate the patient on the influences of caffeine and alcohol so that they could make
an informed decision and also so that I could show the assessors that I was aware of
this. However, on further reflection I can see that this was not in the best interests of
the patient and that it would have been better for me to ask the patient more questions
about the influence the alcohol and caffeine had on their sleep thus letting her come to
(2000) who found that patient’s health improved when their therapy was
collaborative.
Once I had obtained a good understanding of the patient’s problem and she
had agreed with my summary, I continued to follow Richards & Whyte’s (2008)
guidelines and attempted to provide her with some information on depression and
Cognitive Behavioural therapy. I wanted to ensure that the patient fully understood
the cycle of depression and the type of therapy that I could provide. I felt that the best
way to do this was by using William’s (2009) Five Factor Model. To begin with the
patient seemed to recognise that our cognitive, emotional, behavioural and physical
factors were linked and that by changing one we can change the rest. However, as I
continued to explain the different types of therapy I tended to use complicated
terminology such as positive reinforcement and behavioural activation which the
patient did not seem to understand. She began to put her hands on her head and her
facial expressions suggested that she was confused despite saying that she understood.
I began to feel frustrated with myself for not being able to explain the models
properly and as a consequence gave her much more written information on depression
to compensate. I neglected to notice that in her PHQ-9 and GAD 7 forms she had
mentioned that she was having trouble concentrating. In this circumstance my
approach was inappropriate for this patient. Once again I believe that my nerves got
the better of me and my tendency to rush meant that I missed this important piece of
information. I should have used more simplistic and specific examples during my
explanations that allowed her to interact and remain focussed. Therefore, my actions
were incongruent with Richards & Whyte’s (2008) theory and my own beliefs that the
information given to patients should match their needs. Effective clinician-
patient communication has been linked to patient comprehension,
recall, satisfaction, and improved health outcomes. Castro, Wilson,
Wang & Schillinger (2007).
I feel that overall my assessment strategies went well, the patient mentioned
that they felt listened to and that I appeared to have a genuine need to help. However,
I feel I need to slow down my speech, try and be more specific when providing
psycho-education and allow the patient to come to their own conclusions regarding
changes in their life style patterns. In short collaborative. This reflective essay has
been extremely challenging but I feel it has helped me to identify some key issues in
References
Kemmis, S. (1985). Action research and the politics of reflection. In D. Boud & R.
Keogh & D. Walker (Eds.),Reflection: Turning experience into learning (pp. 139-
163). London: Kogan Page.
Kroenke, K., Spitzer, R. & Williams, J.(2001) The PHQ-9 validity of a brief
depression severity measure. Journal of General Internal Medicine. Vol 16, pp. 606-
613.
Lovell, K., Bee, PE., Richards, DA., & Kendal, S. (2006) Self-help for common
mental health problems: evaluating service provision in an urban primary care setting.
Primary Health Care Research & Development. Vo1 l7. pp. 211-220.
Lovell, K. & Richards, D. (2000) Multiple Access Points and Levels of Entry
(MAPLE): Ensuring Choice, Accessibility and Equity for CBT Services.
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Richards, D. & Whyte, M. (2008) Stepped care for common mental health problems:
a handbook for low-intensity workers. Oxford, Wiley.
Spitzer, R., Kroenke, K., Williams, J. & Lowe. (2006) The GAD 7. A brief measure
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pp.1092-1097.
Stewart, M. (2001)Towards a global definition of patient-centred care. British
Medical Journal. Vol. 322, pp. 444-445.
Williams, C (2009). Overcoming Depression and Low Mood: A five Areas Approach
(3rd edition). pp 23-26. Arnold. London.