PART what` and `Now what` to assess the scenario.

PART 2

Here I will assess and reflect on my PWP assessment
completed with an actor portraying the patient. I will be using Driscoll`s
model of reflection (Driscoll 2007), to explore and reflect on the process
myself and explain to the reader how the analysis of my work within this
framework has guided my learning and helped shape future interactions within my
work with patients. Driscoll`s model uses 3 key areas `What`, `So what` and
`Now what` to assess the scenario. This model is an effective way to reflect on
practice and realise the positives and negatives from a situation to inform
learning from the outcome and makes alterations where necessary.

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Reflecting on my work with patients allows for a better
understanding of the areas I need to improve on to become an effective
practitioner. The need for self-analysis and reflection on one’s work is an
excellent opportunity to advance skills and development.

The use of key common skills such as a clear introduction,
verbal and non-verbal competences and a positive, non-judgemental attitude
assist practitioners in gathering information and building an effective working
alliance with patients (Richards and Whyte 2011). 

What

The 45 minute assessment took place with a male patient who
was displaying symptoms of low mood and depression including social withdrawal,
lack of energy, feelings of guild and comfort eating (Papworth et al 2013).

The areas I am going to focus on within the assessment are the
therapeutic relationship and pacing.

When looking at my assessment I firstly recognise the need
for building a therapeutic relationship with the patient as a grounding for the
work to begin (Richards and Whyte 2011). My body language, posture and eye
contact were good, and I believe my use of these factors and non-verbal cues
such as nodding, and hand gestures allowed the patient to feel comfortable
enough to talk to me about their issues (Green et al 2014). I feel my efforts
in this area were good and that I was able to elicit the information in a clear
and coherent manner due to the use of my interpersonal skills in building a
therapeutic relationship. I feel that I demonstrate empathy throughout the
process and understand its importance within the relationship (MacFarlane et al
2017).

When exploring my pacing throughout the session I feel it
started off well and was patient centred but began to become rushed towards the
latter stages of the session. I was feeling quite nervous with this patient as
I was conscious of timing. Due to my counselling background I feel I was
becoming a little too involved with the information gathering stage at the
beginning and could have altered this to allow for more time, so I wasn’t
rushed at the end. It is important for me to reflect on this as my 5 areas
model

 

Working on this area and pacing
myself throughout an assessment should allow for a better result next time
(Roth and Pilling, 2007).

 

 

 

 

 

So What

I feel my interpersonal skills allowed the patient to feel
heard and understood and allowed for a good rapport with them. I aimed to make
questions patient centred and involve the patient in the questioning by
checking their opinions on the answers and information given as this would
hopefully make them more willing to speak and discuss their issues in-depth (Cassar et al., 2016). I realise
questioning skills and interpersonal skills are closely linked and as such the
need for clear questions with the use of the correct competencies such as eye
contact are important as 73% of what the PWP says is in the form of questions (James and Morse, 2007). Checking
information with the patient also allowed them to confirm or correct my
understanding of their situation. 

My
interpersonal skills and use of questioning allowed the patient to open up and
explore the symptoms such as low mood, no energy and trouble sleeping, which
pointed towards a provisional diagnosis of depression within the criteria of
the DSM-V (American Psychiatric Association 2013).

With regards
to my pacing of the session I feel it was initially good and flowed well with a
clear direction of dialogue but feel it was rushed towards mid-session. On
reflection of this session I was nervous, concerned about making mistakes
(Leahy, 2003) and having perfect standards in the delivery (Haarhoff and
Kazantzis, 2007).  An example of bad pacing is my 5 areas model (Williams,
2001) felt rushed as I was beginning to run out of time due to taking more time
than needed on my 4 W`s section. This section is important as it allows for
collaborative decision making for treatment areas and if rushed may hinder this
process (Williams and Garland 2002). I feel the patient did respond to this
area and I did check their understanding, but this could have been don in a
more thorough manner as I only took two minutes to explain the model and how
their issue fitted into the model. I did return to the model when explaining
the treatment options, but this might have been better presented at the initial
viewing of the model as it allows the patient to see links between their situation,
symptoms and how the intervention could help break the cycle (Williams and
Garland 2002).

I don’t feel my 5 areas (Williams,2001) and explanation of
the intervention were very patient centred or collaborative due to my anxiety
over timing and my patient was not as involved in the shared decision-making process
as I they should have been (NICE 2017).

I did ask the patient if they understood what was needed
from them with regards to the out of session work but again feel this was rushed
due to poor time management.

I will work on my time management within supervision to develop
my skills in this area

 

Now What

I feel my session went quiet well for a first attempt despite
my nerves and concern about making errors (Leahy, 2003). I feel I was
able to build a therapeutic alliance with the patient and illicit the
information needed to make a provisional diagnosis despite the short period involved
(Gilbert and Leahy, 2007).

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