Develop your own nursing practice

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This essay will discuss one aspect of care, from a service user’s perspective, and consider the way in which the knowledge gained can help a student to develop their practice. The aspect of care chosen for discussion was the advice given to a service user who visited his general practitioner complaining of the symptoms of depression. The rationale for the choice was the fact that depression was considered to be a significant current issue since it is a common condition. According to Depression Alliance and SANE (2007) depression is the most common mental health problem in the UK, affecting as it does, between eight and twelve per cent of the population in any year.

Moreover, the majority of people with depression receive almost all their care from their general practitioner (GP). The National Institute for Health and Clinical Excellence (NICE) (2004) found that eighty per cent of depression was managed in primary care. Therefore, it was considered relevant to interview a client who had recent experience of visiting their GP for advice on depression and to discuss the patient’s experience of care. Additionally, Faulkner (1997) postulated that depression is thought to be responsible for seventy per cent of suicides in the United Kingdom, making the issue pertinent to a student healthcare professional, whatever branch they are studying.

A client, referred to as Mr. S, in order to maintain confidentiality, in line with NMC Code of Professional Conduct, was interviewed concerning a visit made to a GP. Mr. S related that he explained to his doctor that he had been having difficulty sleeping, lacked concentration, had no confidence, he did not want to go out and mix with people and he felt very low. Mr. S. recounted that after relaying his symptoms to his GP she immediately diagnosed depression and within minutes had prescribed medication. He stated that he was given little explanation of what the medication was, or even why Mr. S might be feeling like that. He 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.

Mr. S. conveyed his feelings of dissatisfaction after his appointment, especially as he had been so nervous and apprehensive about seeing the doctor in the first place. He said he had suspected that he had a mental health problem but felt ashamed and embarrassed about admitting it because he was worried about what people would think of him. The British Medical Bulletin (2001) reported that a diagnosis of depression made some patients feel shameful and secretive and caused them to feel stigmatised.

Mr. S. got the impression that his GP was too busy to listen to him that day and felt that she had “fobbed him off” quickly and had not listened to him properly. He was unhappy that he had not been given adequate time to explain more about how he was feeling. However, this differs from the experiences of the majority of patients surveyed by 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 (eighty per cent) stated their GP was interested in seeing them and hearing about their symptoms.” Depression Alliance and SANE (2007:8) It may therefore be suggested that although Mr. S had an unfortunate experience, he was in a minority, because most clients were satisfied with their experience of care. The evidence would suggest that all health professionals, including nurses, should always make the client feel that they were interested in what they had to say. Mr. S felt he had not been given any helpful feedback or advice by his doctor and that he had been prescribed medication to get rid of him quickly and he was unhappy that his GP had not asked him more about how he felt.

Sixty-one per cent of patients surveyed by Depression Alliance and SANE (2007) agreed with Mr. S 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 (2007:9). This evidence would have implications for a students’ approach to nursing care in that they should be aware that they need to understand how certain conditions make clients feel.

Due to his dissatisfaction, Mr. S decided to investigate the issue of depression for himself by accessing the World Wide Web. Depression Alliance and SANE (2007) suggested that people questioned in their survey said they were as likely to turn to the Internet for information as they were to approach their GP. Mr. S said that on the Internet he had discovered various support groups and charities offering valuable advice about symptoms, medication, information for families and support groups in his area. He said he had contacted the charity AWARE who held meetings locally two evenings a month and he had found the support and advice they gave him invaluable.

It may have been more helpful if Mr. S. had been referred by his GP to a community psychiatric nurse at the practice who could have explained to him other therapies which were available, including counselling and given him literature pointing him towards self help and charities that could have given him advice. Also he was not told about the benefits of complementary therapies such as massage, yoga, homeopathy and acupuncture for depression and how physical exercise such as swimming may help. However, Pilkington, Rampes and Richardson (2006) cautioned that there were questions that still needed to be answered with respect to the effectiveness and appropriate role of complimentary therapies.

It may have been helpful if a holistic approach had been taken to Mr. S’s care and he had been given a list of registered complimentary practitioners. He related that he had found his local support group particularly helpful because he could discuss his experiences with other’s who understood how he felt, and he had met people who had recovered from depression, and others who had managed to live with it. Mr. S wondered why his GP had not told about where to access help but had just given his medication.

In conclusion, it may be suggested that, after considering Mr. S’s experience of care, the implications for a student’s professional development are that health care professionals should always listen to clients and make the client feel that the carer is interested in them. It may also be useful for a student’s development to understand the part that complimentary therapies and exercise programmes may have to play in a client’s care, alongside medication.

References

NMC Code of Professional Conduct (2004)

British Medical Bulletin (2001) “Stigma of depression – a personal view” Oxford University Press Volume 57, Number 1 pp221-224

Depression Alliance and SANE (2007) Now We’re Talking – Enhancing The Care Pathway for Depression, http://www.sane.org.uk/public_htm/News/pdfs/NowWereTalkingReport.pdf [last accessed 17 April 2007]

Faulkner, A. (1997) “Suicide and deliberate self-harm” Mental Health Foundation Briefing Paper 1

National Institute for Health and Clinical Excellence (NICE), (2004) Depression: management of depression in primary and secondary care. Clinical Guideline 23 December 2004

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