The following intervention analysis will utilize a planned verbal interaction, which occurred as part of ongoing care, during a 15-week placement on a Psychiatric Acute ward catering for people aged 18-65. The client's informed consent was gained verbally, to use this conversation within my assignment. The client will be referred to as Carol. These measures are in accordance with the UKCC (1998) guidelines regarding consent and confidentiality. A client centered approach is to be employed as an aid to critical analysis of the intervention. It will firstly give a rationale for why this particular intervention was chosen and for the theoretical approach utilized. Biographical details of the client including events leading up to this point, previous conversations and incidents which are relevant to the chosen intervention, can be found in Appendix A. It will outline what a client centered approach involves. Firstly by defining its beliefs and essential core conditions, then by calling on the more practical micro-skills involved.
[...] CLIENT: Only at times, I wouldn't of done it NURSE: Then I would suggest that on that basis you could say your leave went much better CLIENT: Not really, I still felt awful inside NURSE: Yes, but try to focus on the positive things that happened, and not just the negatives CLIENT: That's easy for you to say NURSE: I understand that, but ask yourself what benefits you get from thinking so negatively CLIENT: (Carol remains silent for a long period minute) NURSE: All I can say at this point Carol is that I see it as positive steps forward, how do you see it? [...]
[...] To allow for easier application, Burnard (1999) defines some micro-skills, which may help in the development of a client-centered approach. These include: 1. Questions 2. Reflection/Selective Reflection 3. Empathy building 4. Checking for understanding. I will continue my analyses of the recorded intervention as these skills are stated, attempting through this, to gain some insight into whether my actions were client-centered or not. 1.Questions The first to be discussed is the use of questions. These can be open or closed, leading and confronting (Burnard 1997). [...]
[...] CLIENT: Yeah NURSE: Why don't you think about what we've talked about today, try to look at the positives, think about whether we should try a different approach and we can talk about it the next time we meet. CLIENT: There you go again talk, talk, talk, and talk. (Carol makes a gesture with her hand as if it were talking) NURSE: I think maybe we should leave it there. When would you like to meet again? CLIENT: Whenever NURSE: Tomorrow? [...]
[...] Therefore I chose to utilize a client centered approach and selected this particular intervention because I hoped first, to make sense of it and secondly, it could be inspiring to use a client led approach, as the prescriptive methods widely used in hospitals today (Morrison & Burnard 1990) had not helped. Another contributing factor was, staff attitudes toward the client. These were mostly negative. One member of staff said, “Good luck with her, you will soon find out, she's beyond help". [...]
[...] It seems to rely on a degree of compliance on behalf of the client. A situation we are not always blessed with in acute psychiatric wards. It requires a deep person-to-person understanding, acceptance and awareness, something I sometimes don't have with those closest to me. There are always arguments for and against differing approaches yet I have learnt one way of being which is comfortable and natural. APPENDIX A Biographical details Carol is a 63yr old lady, who first had contact with the mental health services in 1980 suffering from mild symptoms of depression including some suicidal ideation. [...]
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