Reflective practice essay

Delivering Compassionate Care as a Mental Health Nurse
Assessment
Student ID:1809464
Programme: MSc Nursing (Mental Health)
Module Number: HS890
Module Name: Compassionate Care as a Mental Health Nurse
Assignment title:
Number of Words:
Date: 27thMarch, 2019
According to NMC Code 2015 updated 2018 clause 5, we must respect people’s right to confidentiality (Strauss 2016). For the sake of maintaining confidentiality, patient has been refe
ed as Betsy (a pseudonym). The other information in the case study will remain unchanged.
    The Scenario
Betsy, a 58 year old Caucasian lady was refe
ed to the Adult Community Mental Health Unit by her GP for ongoing symptoms of severe depression, anxiety and suicide ideation. Betsy was reported to have undergone difficult times which led her to severe depression. The possible reasons for depression may be attributed to factors like: she could not find a new job after redundancy, her best friend got diagnosed of terminal illness, her father met a fall. She had to care for her father. These circumstances resulted into symptoms like sleeplessness, loss of appetite, feelings of hopelessness and worthlessness, pessimism about the future and thoughts of not worth living. She went to Accident & Emergency department for her consistent suicidal thoughts and overwhelming emotions however she was refe
ed to GP after medication review. GP identified the need of more support for Betsy to control her emotions so she was refe
ed to the community mental health team. She was pessimistic about life and her inability to get a job after redundancy left her hopeless.
Betsy has been living in her own house with her only daughter. She had been working as a banker for several years. Her medications included Citalopram 20 mg-40 mg, Diazepam (PRN).
Betsy’s mother also suffered depression and was on antidepressants before she committed suicide after her non-compliance with medication. Betsy suffered depression after her divorce and the only treatment she could avail was cognitive behavioural therapy (CBT). She also reported to have bullied at school but she used self-help approach to deal with it. Her depressive symptoms were noticeable when she lost her job 3 years ago and it was difficult to get another job. She became lonely as her daughter spent most of the time at work. Social isolation and loneliness influenced her psychologically, mentally and emotionally. Loneliness may be associated with many mental and physical problems, reduced life satisfaction, low self-esteem and sadness (Fo
est, 2011).
Betsy was provided multidisciplinary treatment with individualized care plan and medications. She was consistently improving in her mental illness until her best friend died of the terminal illness. This incident set her back again and she got disengaged with the medical team. All the contacts made were ignored by her and she did not answer any phone calls. She also did not allow us enter inside during our home visit.
After some days, Betsy’s daughter called the medical care team and informed that had committed suicide by taking overdose of prescribed medicines.
The case study seems to have lack of compassionate care and inability to develop strong therapeutic relationship between the medical team and the patient. The patient’s consistent encounter with depressive incidents and failures led to development of regular lows in the life. The care plan though involved multidisciplinary approach could not enhance her
Dziopa(2008) emphasised that therapeutic relationship need to be based on empathy which is achieved through active listening. The sense of being present can be shown by reacting to the patient in different ways of communication (Bryant-Jefferies, 2006). I think that we could not actively indulge with Betsy to revive her low mood tendency into a positive one. Our relationship could not develop adequate care and compassion which could pull her up from the state of severe depression.
Betsy has been living all alone in her life and has been losing all her support in the family. Her divorce from her husband, death of her best friend and hospitalization of her father after a fall imposed additional burden on her shoulders to take care of his health. It developed loneliness in her life.
We as a practitioner need to develop empathy by tuning into the patient’s feelings in a non judgemental way. We also need to praise the progress in patients’ health. To demonstrate approachability, we need to share relevant personal information with the patient, and exhibit a friendly bearing to develop a rapport. To extend support for the patient, we need to have a caring attitude, flexibility and proactivity in approach. Through active listening, we can trigger attentiveness, focus and thoughtfulness in patient, so that she could express herself with a more positive outlook.
Understanding is the basis of development of therapeutic relationship in nursing. Dziopa(2008) stipulates that understanding instils sense of importance among patients which ove
ides stigmatization. It
ings about patients understanding their own care to influence their treatment and thus promotes individualised care (Percival, Donovan, Kessler and Turner, 2017). Our primary care lacked careful psychiatric management, and could not maintain effective therapeutic alliance with Betsy. Our approach also did not effectively adhered to three phases of pharmacotherapy: Acute, continuation and maintenance phase. Betsy required a careful monitoring of a Psychiatrist and not that of a General Practitioner. She lacked any support system, and had undergone recu
ent chronic depression. During her first stage of mild depression during young age, she could not avail any effective treatment except Cognitive Behavioral Therapy (CBT). She should be given medications along with the CBT. It would have provided her effective recovery from...