Clinical care case study. Mrs. Burton was left with a mixture of emotion mostly feeling of dissatisfaction after her appointment, especially as she had been so nervous and apprehensive about seeing the doctor in the first place. Mrs. Burton had suspected

University Degree Medicine and Dentistry

Name: Nazrean Sajawal GT Group: 12 Guidance Tutor: Fiona Watson

Foundation Studies

Intake: March 2010 Cohort

Module Marker:

Submission Date: 4th January 2011

Module Title:

This assignment will be identifying a service user from my clinical placement as well as discussing an episode of care that was received from a service user’s perspective. This occurred during one of the days that the student nurse worked at the clinical placement. The term for person centre care is mentioned frequently in the older people literature, particularly in dementia care. Brooker (2004, p.219) proposes that ‘in person-centred care the relationships between all the people in the care environment should be nurtured’. Similarly, McCormack (2004) proposes that relationships, environmental conditions and individual values epitomise person-centred gerontological nursing.

The name of patient and the clinical placement will not be named as it preaches one of the codes of conduct from the Nursing and Midwifery Council, which is confidentiality (NMC, 2008). Throughout the assignment the service user will be called Mrs. Burton. The nurse patient relationship appears to be good between the student nurse and Mrs. Burton. Therefore, it was consider relevant to interview Mrs. Burton who had a positive and negative experience on care that they had received. There will also be relevant literature to underpin the care that Mrs. Burton had receive when being diagnosed with depression, as well as the rational of choosing Mrs. Burton.

The rationale for choosing Mrs. Burton were both professional and personal rationale as the professional rationale for choosing Mrs. Burton was the fact that she was an elderly woman who is suffering from depression. I am fascinated with her condition as a student nurse perspective to gain knowledge and understand of how and what causes the different types of mental illness such as depression in my particular nursing branch. Depression has been considered to be an issue in which the government and the NHS are worry about this as depression is the most common mental health problem in the UK, affecting as it does, between eight and twelve percent of the population in any year, according to Depression Alliance and SANE (2007). Furthermore studies show that the majority of people with depression receive almost all their care from their general practitioner (GP). The National Institute for Health and Clinical Excellence also known as NICE (2004) found the eight per cent of depression was managed in primary care. The personal rationale for choosing Mrs. Burton was because I work with her throughout my clinical placement, in which I understand her as a person mostly her needs and preference. This is important for me to establish a nurse-patient relationship with Mrs. Burton in order to provide a good and appropriate communication as well as care that she is entitle to.

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Mrs. Burton visited her GP in regards to her health in which she was concern about. She explained to her doctor that she had been having difficulty sleeping, lacked concentration, had no confidence any more since the losing her partner for many years. Mrs. Burton also stated that “I did not want to go out and mix with people and she felt very low”. Mrs. Burton was relaying on the GP to guide her on the symptoms in which she was stating. However, the GP did not give her any explanation or reassurance but to say that she was suffering with depression. Mrs. Burton felt that the GP immediately diagnosed depression and within minutes had prescribed medication. She recalls that she was given little explanation of what the medication was, or even why she might be feeling like that. Mrs. Burton was informed that the medication would take between four to six weeks to have an effect and therefore to book a review appointment with her in six weeks time.

Mrs. Burton was left with a mixture of emotion mostly feeling of dissatisfaction after her appointment, especially as she had been so nervous and apprehensive about seeing the doctor in the first place. Mrs. Burton had suspected that she had a mental health problem but felt ashamed and embarrassed about admitting it because she was worried about what people would think of her. According to Kenworthy et al (2002) people with mental health problems are often stigmatised or feared by the general public. This is a view that is shared by the World Health Organisation (2001), the Scottish Association for Mental Health (2002) and the Mental Health Foundations (2002) who all identified discrimination as a cause for concern towards patients with depression or any other mental health related illnesses.

Mrs. Burton got the impression that his G.P was too busy to listen to him that day and felt that she had “wasted his time on silly issue” as well as not listening to him properly. She was unhappy that he had not been given her the adequate time to explain more about how she was feeling. However, this differs from the experiences of the majority of patients’ surveyed from the Depression Alliance and SANE (2007). They asked four hundred and fifty people with depression to share their thoughts on depression management. They reported: - “the majority of people with depression (eight per cent) stated their GP was interested in seeing them and hearing about their symptoms.”

The evidence would suggest that all health professionals including nursed should always make the client feel that they were interested in what they had to say. Mrs. Burton felt he had not been given any helpful feedback or advice by his doctor and felt he had been prescribed medication to get rid of him and he was unhappy that his GP had not asked him more about how he felt. Sixty one per cent survey by Depression alliance and sane (2007) agreed with Mrs. Burton that GPs needed a better understanding of how depression makes you feel. They stressed that this would lead to an important improvement in the provision of care Depression alliance and sane (2007). This evidence would have implications for a student approach to nursing care in that they should be aware that they need to understand how certain condition makes patients feel.

Due to her dissatisfaction Mrs. Burton return to home and asked her granddaughter to investigate the issue of depression this is by accessing the internet and books. Her granddaughter is a trainee nurse who has had little knowledge and understanding of the term depression in which she had learned at university. Mrs Burton wanted to know more about the medication that the GP had prescribed, as she did not know what benefits of taking the medication could do for her health and the side effects to this. She was quite happy that her family such as her granddaughter could assist her needs. NICE Guideline (2009) and McCormack’s (2004) have argued that families and carers can play an important part in supporting a person with depression, particularly if their symptoms are severe. This can be helping them with daily tasks or activities that need to be doing.

Looking at the experience that Mrs. Burton was going through the key issue of this episode of care, was communication as well as not being to have any option or choices on the care she should be receiving such as cognitive behaviour therapy or group session. However Mrs. Burton felt that there was no explanation given by the GP on how he came to the conclusion that she was suffering with depression. Surely the GP has to be conducting an initial assessment in order to diagnose her for depression. Stott (1996) highlights that the GP need to carry out the initial assessment in order for client and the GP can work together in order to recognise the clients functional deficits and also his/her areas of ability and Wilkinson (2002) argues that without accurate and comprehensive assessment, other elements of the nursing process such as planning, implementation and evaluation will be informed by flawed information. Mrs. Burton says she did not notice whether or not she was being assessed by the GP.

Studies have shown from the Depression Alliance (2007) that patients can sometimes do not listen to the full conversation which is why some patients take another person with them such family or friend to listen in the conversation between patient and GP or any other health care professional. Depression Alliance (2007) notes that over ninety per cent of people with depression and anxiety who seek help from a health professional are seen in primary care. However, the GP may not be able, or even be best placed, to respond to all the needs of people with depression and anxiety. Due tot the fact that they are not specialised in mental health, however they have the general knowledge for different areas of health. Overall of the negative experience of care in which Mrs Burton received may have not promoted person centre care. Even though the National Service Framework (NSF) for Older People (DH 2001) identifies eight standards and standard two is person – centred care. This standard aims to ensure that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries.

However the good experience of care that Mrs Burton received was the support from her family who identified what was depression and went through each issue surrounding depression such as the cause and symptoms of receiving depression and the medication that was prescribed to her by her GP. Mrs. Burton’s granddaughter had helped her through this as she needed to have explanation of how she was diagnosed. Her granddaughter spends time to clarify any issues which linked with depression. Both key issues that have been addressed are important for the patient such as Mrs Burton to receive in order to comply with person centre care. It is the patient who has the authority to choose what care she would like to receive. There are many literatures that support this person centre care framework such as Brooker and McCormack (2004) that suggests how to implement the policy and framework of person centre care.

Overall with Mrs. Burton’s case it has highlighted key issues which has alarmed me that as a student nurse, it is essential to be able to provide time for patients in order for person centre care to work effectively by following the National service framework for mental health: modern standards and service models (1999) which ensure that patients are being treated without discrimination against mental health as well as different intervention to ensure the safety of the patient. For my future nursing practice will depend on the area in which I am going to be working in and my aim is to learn more about mental health issue and illnesses. I also feel that I need to research further into the theory of communicating to patients and dealing with situation in which patients need the knowledge and understanding of their illness. I am also planning to have a discussion with the qualified nurses on the subject of depression and services that are out there for patients who suffer from depression or any other mental health illnesses. For example the Cognitive Behaviour Therapy also known as CBT can help patients to change their behaviour and thoughts into positive (Roth and Pilling 2007).

Other services should have been concluded in the conversation with Mrs. Burton and the GP in order to help Mrs Burton to recover from depression or even minimise the risk of suffering to mild or moderate depression. This can lead to negative thought which can lead patients to suicidal. To have a discussion with the qualified nurse can be appropriate learning and practice which can also help me develop my competence and performance as a student nurse (NMC, 2008).

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