PART 2 Here I will assess and reflect on my PWP assessmentcompleted with an actor portraying the patient. I will be using Driscoll`smodel of reflection (Driscoll 2007), to explore and reflect on the processmyself and explain to the reader how the analysis of my work within thisframework has guided my learning and helped shape future interactions within mywork 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 onpractice and realise the positives and negatives from a situation to informlearning from the outcome and makes alterations where necessary.
Reflecting on my work with patients allows for a betterunderstanding of the areas I need to improve on to become an effectivepractitioner. The need for self-analysis and reflection on one’s work is anexcellent 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 attitudeassist practitioners in gathering information and building an effective workingalliance with patients (Richards and Whyte 2011). WhatThe 45 minute assessment took place with a male patient whowas 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 thetherapeutic relationship and pacing. When looking at my assessment I firstly recognise the needfor building a therapeutic relationship with the patient as a grounding for thework to begin (Richards and Whyte 2011). My body language, posture and eyecontact were good, and I believe my use of these factors and non-verbal cuessuch as nodding, and hand gestures allowed the patient to feel comfortableenough to talk to me about their issues (Green et al 2014).
I feel my effortsin this area were good and that I was able to elicit the information in a clearand coherent manner due to the use of my interpersonal skills in building atherapeutic relationship. I feel that I demonstrate empathy throughout theprocess and understand its importance within the relationship (MacFarlane et al2017). When exploring my pacing throughout the session I feel itstarted off well and was patient centred but began to become rushed towards thelatter stages of the session. I was feeling quite nervous with this patient asI was conscious of timing. Due to my counselling background I feel I wasbecoming a little too involved with the information gathering stage at thebeginning and could have altered this to allow for more time, so I wasn’trushed at the end. It is important for me to reflect on this as my 5 areasmodel Working on this area and pacingmyself throughout an assessment should allow for a better result next time(Roth and Pilling, 2007).
So WhatI feel my interpersonal skills allowed the patient to feelheard and understood and allowed for a good rapport with them. I aimed to makequestions patient centred and involve the patient in the questioning bychecking their opinions on the answers and information given as this wouldhopefully make them more willing to speak and discuss their issues in-depth (Cassar et al., 2016). I realisequestioning skills and interpersonal skills are closely linked and as such theneed for clear questions with the use of the correct competencies such as eyecontact are important as 73% of what the PWP says is in the form of questions (James and Morse, 2007).
Checkinginformation with the patient also allowed them to confirm or correct myunderstanding of their situation. Myinterpersonal skills and use of questioning allowed the patient to open up andexplore the symptoms such as low mood, no energy and trouble sleeping, whichpointed towards a provisional diagnosis of depression within the criteria ofthe DSM-V (American Psychiatric Association 2013). With regardsto my pacing of the session I feel it was initially good and flowed well with aclear direction of dialogue but feel it was rushed towards mid-session. Onreflection of this session I was nervous, concerned about making mistakes(Leahy, 2003) and having perfect standards in the delivery (Haarhoff andKazantzis, 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 timethan needed on my 4 W`s section. This section is important as it allows forcollaborative decision making for treatment areas and if rushed may hinder thisprocess (Williams and Garland 2002). I feel the patient did respond to thisarea and I did check their understanding, but this could have been don in amore thorough manner as I only took two minutes to explain the model and howtheir issue fitted into the model. I did return to the model when explainingthe treatment options, but this might have been better presented at the initialviewing 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 andGarland 2002).
I don’t feel my 5 areas (Williams,2001) and explanation ofthe intervention were very patient centred or collaborative due to my anxietyover timing and my patient was not as involved in the shared decision-making processas I they should have been (NICE 2017). I did ask the patient if they understood what was neededfrom them with regards to the out of session work but again feel this was rusheddue to poor time management. I will work on my time management within supervision to developmy skills in this area Now WhatI feel my session went quiet well for a first attempt despitemy nerves and concern about making errors (Leahy, 2003). I feel I wasable to build a therapeutic alliance with the patient and illicit theinformation needed to make a provisional diagnosis despite the short period involved(Gilbert and Leahy, 2007).