The medical model of health is a negative one: that is, that health is essentially the absence of disease. Despite bold attempts by bodies such as the World Health Organisation (WHO) to argue for a definition of health as ‘a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity’, most medically related thought remains concerned with disease and illness.

-The main point of this model of disease is that it attempts to uncover underlying pathological processes and their particular effects.

-The pathologically based and causally specific medical model became increasingly dominant. In the medical model of disease, tuberculosis is defined as a disease of bodily organs following exposure to the tubercle bacillus. The development of the illness involves symptoms such as coughing, haemoptysis (coughing up blood), weight loss and fever. In this model the underlying cause of the illness is the bacillus, and its elimination from the body (through anti-tubercular drugs) is aimed to restore the body to health.

-In the case of tuberculosis, the symptoms described above are also found in other diseases, and this problem of linking symptoms to specific underlying mechanisms frustrated medical development.

-Today, these are often referred to as forms of ‘complementary medicine’ – herbalism and homeopathy, for example – that treat symptoms ‘holistically’ – but do not rest on the idea of underlying, specific pathological disease mechanisms.

-The medical model was essentially individualistic in orientation and, unlike earlier approaches, paid less attention to the patient’s social situation or the wider environment. This narrowing of focus (towards the internal workings of the body, and then to cellular and sub-cellular levels), led to many gains in understanding and treatment, especially after 1941, when penicillin was introduced, and the era of antibiotics began. But it was also accompanied by the development of what Lawrence calls a ‘bounded’ medical profession, that could pronounce widely on health matters and could act with increasing power and autonomy. Doctors now claimed exclusive jurisdiction (authority) over health and illness, with the warrant of the medical model of disease as their support.

This situation meant that modern citizens were increasingly encouraged to see their health as an individual matter, and their health problems as in need of the attention of a doctor. It is this which Foucault (1973) saw as constituting the ‘medical gaze’ which focused on the individual and on processes going on inside the body – its ‘volumes and spaces’. Wider influences on health, such as circumstances at work or in the domestic sphere, were of less interest to the modern doctor. This ‘gaze’ (extended in due course to health-related behaviours) underpinned the development of the modern ‘doctor-patient’ relationship, in which all authority over health matters was seen to reside in the doctors’ expertise and skill, especially as shown in diagnosis. This meant that the patient’s view of illness and alternative approaches to health were excluded from serious consideration. Indeed, the patient’s view was seen as contaminating the diagnostic process, and it was better if the patient occupied only a passive role.

It is for this reason that the ‘medical model’ of disease has been regarded critically in many sociological accounts. The power of the medical model and the power of the medical profession have been seen to serve the interests of ‘medical dominance’ rather than patients’ needs (Freidson 1970/1988, 2001) and to direct attention away from the wider determinants of health. However, before we proceed, two caveats need to be entered. Whilst medicine in the last 20 years has continued to focus on processes in the individual body, such as the chemistry of the brain or the role of genes in relation to specific diseases, the current context is clearly different from that which existed at the beginning of the twentieth century. Today, in countries such as the UK and the USA, infectious diseases are of far less importance as threats to human health.

The biopsychosocial model in medical research: the evolution of the health concept over the last two decades

1. Introduction

The traditional biomedical paradigm has its roots in the Cartesian division between mind and body, and considers disease primarily as a result of injury, infection, inheritance and the like. Although this model has been extraordinarily productive for medicine, its reductionistic character prevents it from adequately accounting for all relevant medical aspects of health and illness [1 and 2]. One of the most criticised consequences of adopting the biomedical model is a partial definition of the concept of health. If disease consists only of somatic pathology-or, more strictly and according to the influential work of Virchow [3], cellular pathology-health must be the state in which somatic signs and symptoms are not present. According to this view, the World Health Organization defined health simply as the “absence of disease” [4].

In his classic papers, Engel [1 and 5] explicitly warned of a crisis in the biomedical paradigm and conceptualised a new model which regards social and psychological aspects as giving a better understanding of the illness process [6]. In recent years, the so-called biopsychosocial model has found broad acceptance in some academic and institutional domains, such as health education, health psychology, public health or preventive medicine, and even in public opinion. It is now generally accepted that illness and health are the result of an interaction between biological, psychological and social factors [7, 8 and 9]. Many authors now include mental and social aspects in their definitions of health [10, 11, 12 and 13].

It might be expected that, in the two decades since Engel’s call for a biopsychosocial framework, the concept of health implying social and psychological components would also have extended to practical contexts. The purpose of the present study is to find out whether and to what extent the biopsychosocial concept of health has spread among medical researchers.

4. Discussion and conclusions

In western culture, at least since the advent of Cartesian dualism, medicine has used a mechanistic approach to human nature and has centred its interest around illness and its signs.

-The main reason for the failure of psychological and social measures in the reports examined lies in the still deep-rooted dominance of the biomedical model which, despite the criticism of its reductionism, remains useful and still enables advances in medicine. This dominance has surely been reinforced in recent years because of the push of genetic research and therapies. Perhaps, holistic and biological-reductionistic models should not compete but try to coexist, as two different but not necessarily incompatible possibilities for approaching health questions. The result would be, however, a reduction of biomedical terrain. First, clinical and health psychology have demonstrated their capacity to explain and treat many somatic symptoms. Second, some holistic medical models-such as Traditional Chinese Medicine or Hanneman’s homeopathy-are gaining ground because of patients who do not find satisfactory solutions in biomedical care. Third, biomedical care implies enormous and rapidly-rising costs that are beginning to exceed the budget of the health care systems.

4.2. Practice implications

The biopsychosocial model has been successfully applied to obtain a better understanding of the disease processes and their causes [18], and also for public health purposes [19 and 20], or to improve physician-patient relations [21 and 22], but medical practitioners are still reluctant to incorporate it into treatment plans [16]. Holistic approaches remain till now restricted to chronic illness management [23], which is the field of medical care where regaining health, in a biomedical sense, is not the main goal.

For the medical practitioner, the difficulties attached to the change from a biomedical to a biopsychosocial model of health can be well understood. First, this change necessarily implies taking into account a much wider spectrum of the factors influencing health and the healing process, which in turn demands greater knowledge and time investment. Second, the new paradigm implies a new style of the patient-doctor relationship, a style which enables, among other things, the doctor’s attention to the patient’s psychosocial circumstances, in order to better manage his or her situation, and not only his or her illness. Undoubtedly, this kind of interaction requires a greater effort from practitioners, but also from the health care systems, which should provide the necessary context and resources for it, such as communication skills training, adequate settings, or enough personnel.

Despite these hindrances, which will probably continue to relegate the biopsychosocial model to a secondary place in medical practice, the broadening of the doctor’s perspective to encompass psychological and social aspects would be really beneficial for the patient, since as Engel [24] lucidly pointed out, even though both patient and doctor may culturally adhere to the biomedical model, the patient’s needs and ultimate criteria are always psychosocial.

What Is the Biomedical Model? (wise geec)

The biomedical model is a theoretical framework of illness that excludes psychological and social factors. Followers of this model instead focus only on biological factors such as bacteria or genetics. For example, when diagnosing an illness, most doctors do not first ask for a psychological or social history of the patient. The biomedical model is considered to be the dominant modern model of disease.

According to this model, good health is the freedom from pain, disease or defect. It focuses on physical processes that affect health, such as the biochemistry, physiology and pathology of diseases. It does not take social or psychological factors into account.

The biomedical model is often referred to in contrast with the biopsychosocial model. In 1977, George L. Engel published an article in the well-known journal Science that questioned the dominance of the biomedical model. He proposed the need for a new model that was more holistic. Although the biomedical model has remained the dominant model since that time, many fields, including medicine, nursing, sociology and psychology, use the biopsychosocial model at times. In recent years, some professionals have even begun to adopt a biopsychosocial-spiritual model, insisting that spiritual factors must be considered as well.

Proponents of the biopsychosocial model look at biological factors when assessing and treating patients, just like users of the dominant model do. They also look at other areas of patients’ lives, however. Psychological factors include mood, intelligence, memory and perceptions. Sociological factors include friends, family, social class and environment. Those who examine spiritual factors also assess patients based on their beliefs about life and the possibility of a higher power.

Scholars in disability studies describe a medical model of disability that is part of the general biomedical model. In this medical model, disability is an entirely physical occurrence. According to the medical model, being disabled is negative and can only be made better if the disability is cured and the person is made normal.

Many disability rights advocates describe a social model of disability, which they prefer. This social model opposes the medical model. In the social model, disability is a difference – neither good nor bad. Proponents of the social model see disability as a cultural construct. They point out that a person’s experience of disability can decrease through environmental or societal changes, without the intervention of a professional and without the disability being cured.

Explain the main determinants of health: age, sex and hereditary factors, lifestyle, housing, social class etc.:

The determinants of health

Introduction

Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.

The determinants of health include:

the social and economic environment,

the physical environment, and

the person’s individual characteristics and behaviours.

The context of people’s lives determine their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants-or things that make people healthy or not-include the above factors, and many others:

Income and social status – higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.

Education – low education levels are linked with poor health, more stress and lower self-confidence.

Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions

Social support networks – greater support from families, friends and communities is linked to better health. Culture – customs and traditions, and the beliefs of the family and community all affect health.

Genetics – inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.

Health services – access and use of services that prevent and treat disease influences health

Gender – Men and women suffer from different types of diseases at different ages.

Success of NHS was also its Achilles heel – demand increased

The scale and nature of the problem:

Incidents involving incorrect medication dosage

Incidents involving the use of technical procedures

A number of women became pregnant following failure of earlier sterilisations which had been carried out by laparoscope (keyhole surgery). The surgeon had attached the sterilisation clips to the wrong part of the Fallopian tube.

Incidents involving failures in communication

A man admitted to hospital for an arthroscopy (an exploratory operation) on his knees had a previous history of thrombosis (blood clots). This was noted by a nurse on his admission form, but was not entered on the operation form which had a section for risk factors and known allergies. The operation was carried out and the patient was discharged from hospital the same day. Given his history of thrombosis the patient should have been given anticoagulant drugs following his operation, but because his history had not been properly recorded none were given. Two days later he was admitted to the intensive care unit of another hospital with a blood clot in his lungs

The impact of adverse events on individuals

2.15 Adverse events involve a huge personal cost to the people involved, both patients and staff. Many patients suffer increased pain, disability and psychological trauma. On occasions, when the incident is insensitively handled, patients and their families may be further traumatised when their experience is ignored, or where explanations or apologies are not forthcoming. The psychological impact of the event may be further compounded by a protracted, adversarial legal process. Staff may experience shame, guilt and depression after a serious adverse event, which may again be exacerbated by follow-up action. [20,21]

2.16 The effect of adverse events on patients, their families and staff is not sufficiently appreciated and more attention should be given to ways of minimising the impact of adverse events on all those involved. These issues, while of great importance, cannot be fully addressed within this report and may require separate attention, though we made some limited comment in the context of our discussion on litigation in chapter 4.

Conclusion

Information on the frequency and nature of adverse events in the NHS is patchy and can do no more than give an impression of the problem.  Information from primary care is particularly lacking;

The financial costs of adverse events to the NHS are difficult to estimate but undoubtedly major – probably in excess of £2 billion a year;

There is evidence of a range of different kinds of failure, and of the recurrence of identical incidents or incidents with similar root causes;

Case studies highlight the consequences of weaknesses in the ability of the NHS as a system to learn from serious adverse events;

There is a need for further work focusing specifically on how the impact of adverse events on patients, their families and staff can be minimised.

From the ‘cradle to the grave’, increasing aging population etc:

Britain’s population is ageing fast, with statisticians predicting a huge increase in the number of 100 year olds by the next century.

With people living longer and longer because of medical and other advances, health experts believe the number of people suffering from debilitating conditions such as cancer and heart disease will grow and could mean a rising demand for nursing care.

Health experts are worried that as people get older, they could become prone to an increasing number of debilitating conditions if they do not keep active.

The WHO has launched a campaign to promote good health in old age.

Doctors in the UK say people have an over-gloomy picture of old age and that there is no reason why they should have a lower quality of life than other people if they keep healthy.

People do have anxiety that there will be a period of disability at the end of their lives.

“But there is no evidence that that is the case if they are encouraged to live a healthy life and this generation of elderly people are in better nick than the previous generation.”

Beating the ageing process

Organisations which campaign for the elderly are in favour of policies which support old people to be as independent as possible and allow them more choice and power over their future. They say cuts in local authority and health budgets mean services like home helps have been “whittled (cut) away”.

Without a boost in those services which support independence, there is likely to be increasing pressure on those that cater for dependence: our hospitals, nursing and residential homes.”

The organisation wants a national strategy which sets a framework that encourages independence and inclusion. It says that such a strategy would be much cheaper than putting people into care homes.

They want to see a wider debate on issues such as who funds long-term care, rationing of care – particularly in the light of increasing technological change, and health promotion.

They argue that the present division between social and health services over long-term care is “artificial and damaging”.

It means people in places funded by social services have to contribute towards their care costs, whereas those in places funded by the NHS get free care.

The aim of this report is to look at a critical incident that occurred in placement and relate this to the theory and knowledge regarding communication and interpersonal skills, so as to demonstrate an understanding of my views on the art and science of reflection and the issues surrounding

reflective practice

. Reflection is part of reflective practice and a skill that is developed. It can be seen as a way of adjusting to life as a qualified healthcare professional and enhancing the development of a professional identity (Atwal & Jones, 2009).

Reflection is defined as a process of reviewing an experience which involves description, analysis and evaluation to enhance learning in practice (Rolfe et al 2001). This is supported by Fleming (2006), who described it as a process of reasoned thought. It enables the practitioner to critically assess self and their approach to practice.

Reflective practice is advocated in healthcare as a learning process that encourages self-evaluation with subsequent professional development planning (Zuzelo, 2010). Reflective practice has been identified as one of the key ways in which we can learn from our experiences.

The incident that was chosen was so for the reasons that the situation made the student aware of inadequacies on his own part and those of the staff on the team, which made him reflect upon the situation and how this could be learned from, so as not to make the same mistake again.

Before the critical incident is examined it is important to look at what a critical incident is and why it is important to nursing practice. Girot (1997), cited in Maslin-Prothero, (1997) states that critical incidents are a means of exploring a certain situation in practice and recognising what has been learned from the situation. Benner (1984, cited by Kacperek, 1997) argues that nurses cannot increase or develop their knowledge to its full potential unless they examine their own practice.

Confidentiality will be maintained as required by the Nursing Midwifery Council Code (NMC, 2008).

MODELS

In order to provide a framework for methods, practices and processes for building knowledge from practice, there are several models of reflection available. All can help to direct individual reflection.

Reflective models

, however, are not meant to be used as a rigid set of questions to be answered but to give some structure and encourage making a record of the activity.

John’s (2004) model reflects on uncovering the knowledge behind the incident and the actions of others present. It is a good tool for thinking, exploring ideas, clarifying opinions and supports learning.

Another model, Schon (1987), however, identifies two types of reflection that can be applied in healthcare, ‘ Reflection-in-action’ and ‘Reflection-on-action’. Reflection-in-action can also be described as thinking whilst doing. Reflection-on-action involves revisiting experiences and further analysing them to improve skills and enhance future practice.

Terry Borton’s (1970) 3 stem questions: ‘What?’, ‘So What?’ and ‘Now What?’ were developed by John Driscoll in 1994, 2000 and 2007.

Driscoll

matched the 3 questions to the stages of an experiential learning cycle, and added trigger questions that can be used to complete the cycle. However, Driscoll (2006) notes that reflective practice is often represented as a choice for health professionals, whether to be reflective or not to be, about their clinical practice.

Finally, Gibbs (1988) reflective cycle is fairly straightforward and encourages a clear description of the situation, analysis of feelings, evaluation of the experience, analysis to make sense of the experience, conclusion where other options are considered and reflection upon experience to examine what one would do if the situation arose again.

In spite of all these models’ advantages, there are known barriers which prevent practitioners being able to reflect effectively and time plays a huge role. Smyth (2004) questions whether there is any time to think and be reflective because of the busy work environment that practitioners are involved in.

CHOSEN MODEL

In this report, I have chosen to use Gibb’s Reflective Cycle (1988) as a framework, because it focuses on different aspects of an experience and allows the learner to revisit the event fully. Gibbs (1988) will help me to explore the experience further, using a staged framework as guidance and I feel that this is a simple model, which is well structured and easy to use at this early stage in my course. This model comprises of a process that helps the individual look at a situation and think about their thoughts and feelings at the time of the incident; and consists of six stages to complete one cycle. Its cyclical nature starts with a description of the situation. This includes e.g. where were you; who else was there; why were you there; what were you doing; what were other people doing. Next is to analysis of the feelings that is, trying to recall and explore those things that were going on inside your head?

The third stage is an evaluation of the experience; making a judgement regarding the reasons behind the event and its possible consequences.

The fourth stage is an analysis to make sense of the experience. At this stage the event is broken down into its component parts so they can be explored separately. The fifth stage is a conclusion of what else could I have done; the creation of insight through the reflective process towards individual roles within the event being considered. And final stage is an action plan to prepare if the situation arose again. That is, recognitions leading towards behavioural adjustments where faced with similar events in the future (NHS, 2006). The use of this model represents a fundamental shift from the ideas of Kolb in that Gibbs’ model specifically refers to the key processes within reflection itself, rather than as reflection as a process within general learning.

Reflective practice can mean taking our experiences as an initial point for our learning and developing practice (Jasper, 2003). Many literatures have been written in the past that suggest the use of reflective assignments and journaling as tools to improve reflection and thinking skills in healthcare (Chapman et al, 2008). Reflective journals are an ideal way to be actively involved in learning (Millinkovic & Field, 2005) and can be implemented to allow practitioners to record events and document their thoughts and actions on daily situations, and how this may affect their future practice (Williams & Wessel, 2004). The experience gained in this can then be used to deal with other situations in a professional manner.

By contemplating it thus, I am able to appreciate it and guided to where future development work is required.

Context of incident

In the scenario the patient’s name will be given as Xst.   The consequences of my actions for the client will be explained and how they might have been improved, including what I learned from the experience. My feelings about the clinical skills used to manage the client’s care will be established and my new understanding of the situation especially in relation to evidence based practice will be considered.  I will finally reflect on what actions I will take in order to ensure my continued professional development and learning.

Xst is 55 year old woman who has a 10 year old daughter.  She suffers from psychiatric problems, lack of motivation and has difficulties in maintaining her personal hygiene and the cleanliness of her flat. She was one of my mentor’s clients to whom I had been assigned to coordinate and oversee her care under supervision. Nurses owe their patients a duty of care and are expected to offer a high standard of care based on current best practise, (NMC 2008).

Description

Xst had been prescribed Risperidone Consta 37.5mg fortnightly, which is a moderate medication. Risperidone belongs to a group of medicines called antipsychotic, which are usually used to help treat people with schizophrenia and similar condition such as psychosis. Xst did not like attending depot clinic and she missed three consecutive appointments. My mentor decided after the third non-attendance to raise the issue in the handover meeting where it was decided to see Xst in the morning but when we arrived she was not there. We left a note for her to call the office. We did not hear from her and a further home visit was carried out to arrange for her next depot clinic appointment. I was asked to call a meeting of the multi-disciplinary team (MDT) who, at the meeting agreed that there would be a problem if the next injections were missed.

At the next clinic, we waited for about an hour but she failed to attend. At a subsequent meeting with the patient, she agreed a joint visit with the CPN, my mentor and me to re-assess her condition and consider if it was necessary to   refer her case to the Consultant.

I was given the opportunity to participate in the assessment, which showed that her behaviour was very unpredictable and very forgetful. Her inability to take her medication and to manage her personal hygiene clearly demonstrated that she was not well and indeed, had no insight into her illness and was in denial (Barker, 2004). However, the patient had been very upset because of the lack of communication and interpersonal skills that the staff and the student had displayed.

I talked to Xst about her non-concordance with her medication, whilst stroking her hand but she persisted in saying she was well.  I reminded her that continuous use of the medication would benefit her mental health and protect her against relapse.  We agreed that she could discuss this with the doctor on her next outpatient appointment, with the option of reviewing or reducing her medication. I stressed the importance of her communicating any side effects or reservations she may have about the medication to doctor. She appeared to understand this and following the discussion, she finally complied with her depot injection.

Feeling

During the handover, I was nervous as I felt uncomfortable about giving feedback to the whole team. I was worried about making mistakes during my handover that could lead to inappropriate care being given to Xst or could cause her readmission to hospital. As a student nurse I felt I lacked the necessary experience to be passing information to a group of qualified staff members.  However, I dealt with the situation with outward calm and in a professional manner. I was very pleased that my mentor was available during the handover to offer me support and this increased my confidence.

Evaluation

What was good about the experience was that I was able to carry out the initial assessment and identify what caused Xst failure to comply with the treatment regime.  From my assessment I documented the outcome and related what had happened to the MDT with minimal assistance. Accurate documentation of patient’s care and treatment should communicate to other members of the team in order to provide continuity of care (NMC, 2008).  The experience has improved my communication skills immensely, I felt supported throughout the handover by my mentor who was constantly involved when I missed out any information. Thomas et al, (1997) explains that supervision is an important development tool for all learners. The team were very supportive throughout the process as they took my information without doubt.

What was not good about the experience was the fact that my mentor had not informed me that I was going to handover the information; as a result I had not mentally prepared myself for it.  I also felt that I needed more time to observe other professionals in the team carrying out their handovers before I attempted to carry out mine.  During the first MDT meeting, I felt that we did not provide enough time to freely interact with Xst to identify other psychosocial needs that could impact on her health. However, in any event, she was unable to fully engage because of her mental state. Turley (2000) suggests that nursing staff should include their interaction with the patient when recording assessment details, which can be used to provide evidence for future planning and delivery of care. Dougherty and Lister (2004) have suggested that healthcare professionals should use listening as part of assessing patient problems, needs and resources.

Analysis

The literature regarding communication and interpersonal skills is vast and extensive. Upon reading a small amount of the vast literature available, the author was able to analyse the incident, and look at how badly this situation was handled. I realised communication is the main key in the nursing profession as suggested by Long (1999) who states that interpersonal skills are a form of tool that is necessary for effective communication. The behaviour of the person listening to the person who is talking is important during the interpersonal process (Burnard, 1992).The author used touch to convey support, genuineness and empathy, which is essential for the helping relationship (Betts, 2002, cited in Kenworthy et al, 2002). Carl Rogers (1967, cited by Betts, 2002, in Kenworthy et al, 2002) recommended three principal conditions necessary for effective counseling: empathic understanding, congruence or genuineness and unconditional positive regard. The terms genuineness and congruence are used interchangeably and used to describe the helper always being real in the helping relationship (Betts, 2002, cited in Kenworthy et al, 2002).

I found it difficult to communicate with the patient initially because I did not understand her condition ( Adams,2008). It was also difficult for me not to take her behaviour to heart and show emotion at the time and thought this to be a failure. Even though the NMC (2008) maintains that nurses have a responsibility to empower patient in their care and to identify and minimise risk to patient, the principle of beneficence (to do well) must be balanced against no maleficence (doing no harm) (Beauchamp and Childress, 2001).  All these transactions were recorded in Xst’s care plan file and on computer. Good record keeping is an integral part of nursing and midwifery practice, and is essential to the provision of safe and effective care. It is not an optional extra to be fitted in if circumstances allow NMC (2009).  The consequences of my actions for the patient and her daughter were that she attended to her daughter’s needs and to her personal hygiene, and made regular fortnightly visits to the clinic. Her mental condition was improved. She was allowed to continue on her moderate medication and she did not have to be readmitted in the hospital.

However, Bulman & Schutz (2008) argue that this failure is to educate and for us to learn from practice and develop thinking skills. I would agree with them, as I learn best from practical experience, and build on it to improve my skills. With this is mind, I am now going to focus on my weaknesses, in both theory and practice, and state how, when and why I plan to improve on these.

Through effective communication I was able to convince Xst of the need to take her medication. I was able to pass on the information to the MDT for continuity of care.   Roger et al (2003) concluded that communication is an on-going process but can be a difficult process when dealing with mental health problems. Whilst talking I attempted to use Egan’s SOLER (Egan, 1990, cited in Burnard, 1992).The SOLER acronym is an aid to identifying and remembering the behaviours that should be implemented in order to promote effective listening (Burnard, 1992). I Sat facing Xst; assumed an Open posture; Leaned towards Xst slightly (in order to express interest); maintained Eye contact and attempted to appear Relaxed, as advised by Egan. During the handover I was pleased that the MDT members were supportive and interested in what I was saying and they asked questions.

My mentor explained that a patient with schizophrenia can often behave like this as they develop dementia, which Noble (2007) also confirms. Since the incident I have read about schizophrenia and I am now aware that the patient’s expressionless face Netdoctor (2008), also made her comments appear more confusing and aggressive.

Conclusion

In conclusion, I have learnt that through effective communication, any problem can be solved regardless of the environment, circumstances or its complexity. Therefore, nurses must ensure they are effective communicators.  I have identified the weaknesses that should be turned to strengths. I am now working on strengthening my assertiveness, confidence and communication skills. Participating in the care of Xst I have realised that a good background information and feedback about mental health problems before providing care to clients can assist in accurate diagnosis and progress monitoring.   A good relationship between client and staff nurse is therapeutic and help in building trust.  This can be achieved by a free communication that allows the client to express their feelings and concern without the fear of intimidation.  From the experience, I feel the knowledge I have acquired will aid me in future practice should such situation arise again.

Action Plan

So that I could identify my strengths and weaknesses in both theory and practice easily, I found that the use of a SWOT analysis provided a good framework to follow. I have then built on this by producing a development plan that focuses on my weaknesses and how, when and why I plan to improve on them. I will now begin to work on these, the main reason being of course, that I am determined to be a competent, professional nurse in the future. I am now more prepared for any future patients with this disease as I have researched it. I will take the time to talk to them, to make sure they are at ease with me, before providing any care. If they appear distressed I would get another member of staff to help me to reassure them.

Learning Need

To improve my knowledge about patients’ illnesses and the risks of relapse associated with not taking medication.

To identify and have good background information and feedback about patients’ mental health problems before providing care to them.

To ensure a good rapport exist between my patient and I, in order to build up a therapeutic relationship with them and to gain their trust.

To have effective communication with the patients and other members of the multidisciplinary team and being prepared.

Planned action to meet these learning needs

I aim to read books about different illnesses and causes of relapse and to read my patient’s notes.

I will be talking with senior members of staff and allocating time to talk to patients and their relatives and participating in the ward round. Finally, I will have regular meetings with my clients.

Target time to meet the learning needs

I hope by the end of third year and some will be on-going skills to develop throughout the training.

CONCLUSION

I have clearly demonstrated that by using a reflective model as a guide, I have been able to break down, make sense of, and learn from my experience during my placement. At the time of the incident I felt very inadequate

It was also difficult for me not to take her behaviour to heart and show emotion at the time, it is clear that this is an area I need to build on for the future. Nursing requires effective preparation so that we can care competently, with knowledge and professional skills being developed over a professional lifetime. One way this can be achieved is through what some writers refers to as technical rationality, where professionals are problem solvers that select technical means best suited to particular purposes. Problems are solved by applying theory and technique.

The invaluable use of non-verbal communication has now become clearer to the author. The author believes he has become more self-aware regarding his own non-verbal communication and hopes that in the future he will use his communication skills to become a better advocate for the patient in his care.